Simultaneous renal clear cell carcinoma and primary clear cell carcinoma of the liver: A case report

Diagnosis of primary clear cell carcinoma of the liver based on Faster region-based convolutional neural network

BACKGROUND

Distinguishing between primary clear cell carcinoma of the liver (PCCCL) and common hepatocellular carcinoma (CHCC) through traditional inspection methods before the operation is difficult. This study aimed to establish a Faster region-based convolutional neural network (RCNN) model for the accurate differential diagnosis of PCCCL and CHCC.

METHODS

In this study, we collected the data of 62 patients with PCCCL and 1079 patients with CHCC in Beijing YouAn Hospital from June 2012 to May 2020. A total of 109 patients with CHCC and 42 patients with PCCCL were randomly divided into the training validation set and the test set in a ratio of 4:1.The Faster RCNN was used for deep learning of patients' data in the training validation set, and established a convolutional neural network model to distinguish PCCCL and CHCC. The accuracy, average precision, and the recall of the model for diagnosing PCCCL and CHCC were used to evaluate the detection performance of the Faster RCNN algorithm.

RESULTS

A total of 4392 images of 121 patients (1032 images of 33 patients with PCCCL and 3360 images of 88 patients with CHCC) were uesd in test set for deep learning and establishing the model, and 1072 images of 30 patients (320 images of nine patients with PCCCL and 752 images of 21 patients with CHCC) were used to test the model. The accuracy of the model for accurately diagnosing PCCCL and CHCC was 0.962 (95% confidence interval [CI]: 0.931-0.992). The average precision of the model for diagnosing PCCCL was 0.908 (95% CI: 0.823-0.993) and that for diagnosing CHCC was 0.907 (95% CI: 0.823-0.993). The recall of the model for diagnosing PCCCL was 0.951 (95% CI: 0.916-0.985) and that for diagnosing CHCC was 0.960 (95% CI: 0.854-0.962). The time to make a diagnosis using the model took an average of 4 s for each patient.

CONCLUSION

The Faster RCNN model can accurately distinguish PCCCL and CHCC. This model could be important for clinicians to make appropriate treatment plans for patients with PCCCL or CHCC.

Hepatocellular carcinoma complicated with huge posterior pancreas head lymph node metastasis and primary renal carcinoma: A case report

The incidence of hepatocellular carcinoma (HCC) associated with extrahepatic primary malignancy (EHPM) is extremely rare, especially for those that involve primary renal cell carcinoma (PRC). Here we present a case of a 66-year-old male who was diagnosed with HCC complicated with lymph node metastasis at posterior pancreas head and PRC. Biopsy results of the liver and the lymph node confirmed the diagnosis of HCC. The disease progressions of both HCC and PRC are controlled effectively following the initiation of comprehensive therapy including pembrolizumab, lenvatinib, radiotherapy, and transcatheter arterial chemo-embolization (TACE). Ultimately, the patient had successfully access to surgery and complete response (CR) of all the tumors were achieved after surgery.

Primary Synchronous Ipsilateral Renal Fibrosarcoma and Renal Pelvic Carcinoma: A Case Report and Literature Review

Renal fibrosarcoma is a rare tumor, with only a few cases reported so far, and simultaneous occurrence of ipsilateral renal fibrosarcoma and renal pelvic carcinoma in a patient is extraordinarily rare. A 66-year-old man admitted to our hospital with right renal percutaneous nephrostomy and recurrent fever. And the patient underwent laparoendoscopic nephrectomy and partial ureterectomy for pyonephrotic nonfunctioning kidneys. Postoperative pathology showed fibrosarcoma of right kidney and carcinoma of the renal pelvis. This is the first case of simultaneous occurrence of ipsilateral renal fibrosarcoma and renal pelvic carcinoma in a patient. The diagnosis of fibrosarcoma is one of ultimate immunohistologic exclusion, because there are no specific immunologic markers for fibroblasts. Electron microscopy combined with light microscopy and IHC is helpful for the case of renal fibrosarcoma which is difficult to diagnose. Clinically, radical nephrectomy is the main strategy for primary localized renal fibrosarcoma. At present, it is still necessary to carry out basic biology research to better understand etiology and therapeutical strategy of renal fibrosarcoma.